Polytrauma

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polytrauma management

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Polytrauma

  1. 1. Management of polytrauma patients at POF Hospital Dr.Monsif Iqbal PGT SU-II
  2. 2. Summary Case Presentation• Miss XYZ,a young lady 0f 23• RTA blunt trauma abdomen• Patient received in A & E• Patient then shifted to ITC
  3. 3. Primary Survey Case presentation • Pulse….122 • BP……..80/55 • GCS……15/15 • Irritable • pallor • Cold & Clammy • Grade 3 shock
  4. 4. FAST Case Presentation FAST performedFrank blood Shatteredin abdominal Spleencavity
  5. 5. Management ResuscitationExploratory Laparotomy
  6. 6. Resuscitation Case Presentation• I/V cannulae• Blood grouping & cross match• Restoration of intra vascularvolume• catheterization• antibiotic• Blood transfusion
  7. 7. Cont. Case Presentation Patient rushed to OT collapsed on OT table Successful CPR done blood transfusion Patient reverted back
  8. 8. managementEXPLORATORYLAPAROTOMY
  9. 9. Findings of exploratory laparotomy Case Presentation• Splenic injury ….grade 5• Renal injury…….grade 4• Lt colon crushed• Abdominal cavity full ofblood• Retroperitonealhematoma
  10. 10. Definitive surgical treatmentFindings of exploratory laparotomy Case Presentation• Splenetomy• Nephrectomy Lt• Sigmoid Colostomy
  11. 11. Post op recovery management • Mechanicl vent for 2 days • Drain output gradually reduced • Pneumovac given • Patient went into DIC with deranged PT & APTT • FFPs and platelets transfused • 7 blood transfusions done gradually • Stoma started working on 2nd POD
  12. 12. Cont….. management• Patient gradually reovered• Urine output remained satistory• Wound….healthy• Stitches out on 11th POD• Patient discharged home on 13th POD
  13. 13. DiagnosisManagement of polytrauma patients Resuscitation & definitive management
  14. 14. Componenets ATLS • Primary survey • Resuscitation • Secondary survey • Definitive management
  15. 15. Primary survey ATLS• A..airway & cervical spine care• B…Breathing & ventilation• C…circulation & hemorrhage control• D…Deformity & disability• E…exposure & environmental cond
  16. 16. Adjuncts to primary survey ATLS • ECG • Urinary & Gastric catheters • ABGs • Pulse oximetry • X-rays & Diagnostic studies
  17. 17. Secondary survey ATLS• History • Examination Blunt ?  Head & neck Penetrating ?  Chest Burn or cold  Abdomen injuries  Extremities  spine
  18. 18. Adjuncts to secondary survey ATLS• Detailed X-rays• CT scan• Angiography• USG• Transportation
  19. 19. Abdominal trauma
  20. 20. Blunt Abdominal trauma
  21. 21. Penetrating Abdominal trauma
  22. 22. Laparotomy
  23. 23. Focused Assessment with Sonography in Trauma FAST• FAST examines four areas for free fluid: – Morrison’s Pouch – Perisplenic – Pelvis – +/-Pericardium
  24. 24. Morrison’s pouch
  25. 25. How good is FAST? FAST• As a decision making tool for identifying the need for laparotomy in hypotensive patients (Systolic BP < 90), FAST has:• a sensitivity of 92%,• specificity of 96%• Accuracy 93%• How good is FAST?
  26. 26. DPL
  27. 27. Specific injuries Polytrauma• Spleen• Kidney• Liver• Intestine• Diaphragm• Pancreas
  28. 28. Spleen
  29. 29. Liver
  30. 30. Liver injuries management• Push• Plug• Pack• pringle
  31. 31. Kidney
  32. 32. Gradesof renal injury
  33. 33. Pancreas
  34. 34. Intestine
  35. 35. Damage control surgery
  36. 36. Colon
  37. 37. Diaphragmatic injury
  38. 38. Statistics of trauma in POF HOspital from jan 2010- jan2011
  39. 39. statistics polytrauma• Head injury….212• Blunt abdominal injury….67• Penetrating abdominal injury….17• Thoracic injury……27• Orthopedic inj…..89• Polytrauma …..56• Mortality…..24
  40. 40. ortho
  41. 41. Managementof Abdominal trauma Blunt abdominal traumaConservative Operativemanagement management 33 34
  42. 42. FAST done…. polytrauma• Total…..57• Positive……30• Inconclusive…..11• Negative……16
  43. 43. Head injury
  44. 44. Mortality
  45. 45. Take home message‘Multidisciplinary approach requiredfor management of polytraumapatient involving generalsurgeon,urlogist,orthpedicsurgeon,anesthetist,radiologist etc’

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